About Body Dysmorphic Disorder
What is Body Dysmorphic Disorder?
Body Dysmorphic Disorder (BDD) is a mental health condition in which an individual is preoccupied with a perceived defect in his or her appearance. This preoccupation causes significant distress and/or impairs functioning. Often the perceived flaw is unnoticeable to others. An important distinction between BDD and body image concerns is the amount of preoccupation and disruption in an individual’s functioning. People with BDD generally spend at least an hour a day thinking about their perceived defect and in the average case, the individual spends between 3 and 8 hours per day. Additionally, they engage in avoidance and/or compulsive behaviors in an effort to alleviate anxiety about their appearance. Current studies suggest that millions of people in the U.S. alone have BDD (Phillips, 2005).
Underdiagnosis of BDD
BDD can be difficult to diagnose for many reasons. Body image and appearance concerns are common. In a recent survey of 30,000 people in the United States, findings suggested that 93% of women and 82% of men care about their appearance and work to improve it (as cited in Phillips, 2005). When people express concerns about their appearance, this may be overlooked since it is a common problem in our culture. Worries about being seen as vain, drawing more attention to the perceived defect, and receiving reassurance that one’s appearance is fine are other reasons BDD is underdiagnosed. Although reassuring comments are typically well-meaning, individuals with BDD may feel that their concerns are dismissed as foolish or invalid (Phillips, 2005).
How does BDD impact functioning?
People with BDD commonly become preoccupied with perceived problems with their appearance such as their hair, skin, and nose. They may worry about acne, scarring, wrinkles, thinning hair or having a large nose. To ease their distress, they engage in avoidance and compulsive behaviors. BDD frequently causes problems in interpersonal relationships and social activities. Individuals with BDD tend to miss school, work or in more severe cases may drop out of school or become unemployed (Phillips, 2005). The most serious consequence is suicide. In a study consisting of more than 500 patients, 80% of people with BDD endorsed suicidal thoughts and 14% reported they attempted suicide because of BDD (Phillips, 2005). Many individuals seek unnecessary cosmetic surgery and dermatologic treatment. While people with regular body image concerns may be happy with the result, individuals with BDD are typically dissatisfied with the outcome and blame themselves or the doctor (Phillips, 2005).
Currently, Cognitive-Behavioral Therapy (CBT) is the best-studied and most recommended form of treatment for BDD. This therapy approach consists of the following techniques: cognitive restructuring, response (ritual) prevention, behavioral experiments, and exposures. Cognitive restructuring involves helping clients to identify and challenge thinking errors regarding appearance concerns. The goal of response (ritual) prevention is to identify compulsive behaviors such as excessive grooming and mirror-checking. The clinician will assist with stopping unhelpful behaviors and help the client develop normal amounts of necessary behaviors such as grooming. Behavioral experiments involve designing and carrying out experiments to test out BDD beliefs. For example, if the belief is “Everyone will stare at me in horror if I go out in public without make-up,” an individual might go to the grocery store without make-up and collect evidence for and against this belief. Exposures consist of gradually facing situations that are typically avoided.
Numerous research studies have demonstrated that serotonin-reuptake inhibitors (also known as selective serotonin reuptake inhibitors) substantially improve BDD symptoms in a majority of people (Phillips, 2005). SRIs are a type of antidepressant medication that can also help to diminish obsessional thinking and compulsive behaviors (Phillips, 2005). Examples of these medications include: citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox) and fluoxetine (Prozac). According to the International OCD Foundation, there are no medications that currently have FDA approval for treatment of BDD. However, research and clinical experience suggest these medications are safe and effective for most individuals who have BDD. Individuals diagnosed with BDD may benefit from working with a psychiatrist who specializes in BDD to determine whether to add medication to the treatment protocol.
Studies have suggested improvement in many aspects of BDD and related symptoms after CBT treatment. Some of the areas include: a reduction in obsessive thoughts and BDD rituals, reduced depressive symptoms, improved insight, body image, and self-esteem and decreased social anxiety (Phillips, 2005).
If you are interested in counseling for Body Dysmorphic Disorder, call OakHeart at 630-570-0050 or 779-201-6440 or email us at Contact.OH@OakHeartCenter.com. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.
Body Dysmorphic Disorder Foundation (n.d.). Information. https://bddfoundation.org/information/
International OCD Foundation (n.d.). Medication Treatment for BDD: FAQ. https://bdd.iocdf.org/expert-opinions/medication-faq/
Phillips, K.A. (2005). The Broken Mirror. Oxford University Press, Inc.
Wilhelm, S., Phillips, K.A., & Steketee, G. (2013). Cognitive-Behavioral Therapy for Body Dysmorphic Disorder. The Guilford Press.